Julie Andrew, Sophie May & Robert Murray

Background: Acute adrenal insufficiency leads to potentially life threatening crises if increases in steroids are delayed or insufficient. The patient is central to early increases in dosage and informing Healthcare Professionals of their steroid-dependency.

Methods: To assess adequacy of information given to cortisol deficient patients we performed an audit of case notes documentation. The audit was performed over four weeks, involving 32 patients from the pituitary clinic. We examined: Education around steroids, including sick day rules The frequency information was given or reiterated. Prescription and demonstration of intramuscular emergency hydrocortisone Medic Alert advice and uptake Communication between healthcare professionals.

Results: Overall findings were encouraging; 90% had steroid information discussed by the Clinician or Specialist Nurse, 65% within the previous 12 months, and in 71% this had been repeated on ≤2 occasions. The majority (75%) had documentation regarding increased steroid dosage in illness, but only 41% regarding steroid cards, medic alert and only 50% had IM hydrocortisone prescribed and demonstrated. Areas highlighted for improvement were Standardisation of documentation. Communication within LTHT, other Trusts, Primary Care and Yorkshire Ambulance service (YAS). A system for patient capture to enable education. Improved communication between Transition teams. Interventions: We have implemented a number of changes to improve and document discussions with steroid-dependent patients: A nurse-led review clinic of steroid information, repeated biannually. A credit card size steroid card with patient and healthcare information. A carbonated review sheet documenting individual aspects of the discussion; with copies for the patient, notes and Nurses masterfile. Discussions with YAS have led to an agreed patient letter to direct attending Paramedics to administer emergency IM hydrocortisone. Both LTHT and surrounding A&E departments have agreed to place alerts on susceptible patients notes. The audit will be repeated in 12 months to assess the impact of interventions.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.